A 75-year-old woman is hospitalized for a bowel obstruction related to adhesions from previous uterine cancer surgery and radiation. She has a history of hypertension, atrial fibrillation, and peripheral vascular disease. After a prolonged hospital course complicated by a pulmonary embolus, she is discharged on multiple medications, including a higher dose of her warfarin. The patient is scheduled for follow-up appointments with her internist, gynecologist, cardiologist, and gastroenterologist. She lives by herself and has been able to successfully manage her care needs in the past. Her adult daughter is supportive but lives out of state. Which of the following interventions would be most effective in improving her adherence to outpatient treatment?

Question

A 75-year-old woman is hospitalized for a bowel obstruction related to adhesions from previous uterine cancer surgery and radiation.  She has a history of hypertension, atrial fibrillation, and peripheral vascular disease.  After a prolonged hospital course complicated by a pulmonary embolus, she is discharged on multiple medications, including a higher dose of her warfarin.  The patient is scheduled for follow-up appointments with her internist, gynecologist, cardiologist, and gastroenterologist.  She lives by herself and has been able to successfully manage her care needs in the past.  Her adult daughter is supportive but lives out of state.  Which of the following interventions would be most effective in improving her adherence to outpatient treatment?

Quizplus · Accepted Answer

The transition from hospital to outpatient care is a time of high risk for patients. Individuals with multiple medical problems, complex medication regimens, low health literacy, and poor social support are at particularly high risk. The most effective strategy for decreasing adverse outcomes and preventing avoidable readmissions is a structured approach that uses a comprehensive discharge checklist. The checklist should provide instructions at the appropriate literacy level and patient education materials to facilitate a successful transition from the hospital to the outpatient setting. Key elements of the discharge checklist include detailed instructions regarding medications (their purpose, dosing schedule, and adverse events), follow-up appointments with the primary care provider and any specialists, pending laboratory measurements or tests, and an emergency contact number with specific directions on when to call. Medication changes that have occurred during the hospitalization (eg, new medications, discontinued medications, changes in dose or frequency) should be clearly identified on the checklist to reduce the risk of medication errors. (Choice A) Although emphasizing the importance of adherence to treatment is beneficial, a detailed list with specific instructions regarding medications and follow-up that the patient can refer to at home would be more helpful. Patients are frequently overwhelmed by verbal information at the time of discharge and can benefit from a written checklist. (Choice B) Communication with outpatient specialists is an important component of the discharge process, but it does not help the patient manage the complex follow-up tasks required. (Choice C) A discharge summary is prepared by the hospital physician to document the hospital course and assist other medical providers and support staff in the care of the patient. It uses technical language that may be confusing to the patient. In contrast, the discharge instruction checklist uses simple and clear language intended to optimize patient understanding. (Choice E) Reviewing discharge instructions with the patient's daughter would be appropriate if the patient lived with her or if the daughter was helping the patient obtain medication or was providing transportation to follow-up appointments. Educational objective: A discharge checklist detailing medication changes and follow-up appointments can significantly facilitate a patient's transition from the hospital and improve adherence to outpatient treatment. Individuals who experience a smooth transition from the inpatient to the outpatient setting are at lower risk for early rehospitalization. __________ References: Development of a checklist of safe discharge practices for hospital patients. (http://www.ncbi.nlm.nih.gov/pubmed/23554352)

A 75-Year-Old Woman Is Hospitalized for a Bowel Obstruction Related